Rest Ice Compression Elevation:
RICE for injuries

The regime of rest ice compression elevation (called RICE, ICE, RICES, R.I.C.E., RICEing, etc.) is the standard first-aid method to treat most musculoskeletal injuries (strains, sprains, falls, etc.).[1] And in that function, it's great for any severe injury.

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For normal muscle pain, like from a beginning weight training program, RICE won't help with your soreness. Ice might, but the whole RICE routine is for breaks, sprains, and other big stuff.

In case you're in pain, here's the quick Cliff-notes guide for 'Rest Ice Compression Elevation':

RICE: Cliff-notes Version

• Rest

Stop whatever activity you're doing. Since you're in pain, don't do anything to make it worse.

• Ice

Apply ice to the injury. Preferably ice (not an ice-pack), and apply it as soon as possible after the injury has occurred. Within moments is best.

Initially apply the ice till the swelling stops or up to 30 minutes. Then apply ice intermittently (in 3-5 minute chunks; longer if it feels good) over the next 12-24 hours.

• Compression

Wrap the injured body part in a cloth bandage. Not so tight that it hurts, but just enough to apply firm pressure to the area and, ideally, to help keep down the swelling.

• Elevation

Elevate the injury to decrease blood flow to that area.

• And Stabilization

Over the next few days and/or weeks as you're recovering, bandage your body in a way that allows you to relax and not contract other muscles unnecessarily to support or protect the injured body part.

RICE is a great first aid treatment for acute injuries. But just use it there; it's not so good for chronic injuries and other problems that creep up on you, though components of RICE can help.[2]

The reason to follow this regime as soon as you get hurt is to reduce the amount of damaged tissue, swelling, muscle spasming, and pain. Giving you a faster overall recovery time.[3] And here's how it works…

Rest Ice Compression Elevation: Long Version

◆ Rest

If you injure yourself and it hurts, stop moving! Don't do anything to make the situation worse; just rest for at least the next 24 hours. Though your injury will obviously dictate how long you continue resting...

As far as healing after the first 24 hours - rest means decreased activity not no activity. You should try to get up and start moving around as soon as possible while not causing yourself any pain.

If it hurts, stop doing it. But do try to keep active and move a lot within the range of motion that is pain free when you're recovering after the initial 'Rest Ice Compression Elevation' first-aid.

◆ Ice

In simple terms, ice helps to slow and stop swelling by inducing vascular spasms (causing your blood vessels to contract, and thus not leak blood and fluids into the damaged tissue).[4] In more complicated terms, well...

Inflammation swelling from an injury happens because of both

1. direct hemorrhaging, and
2. edema formation (fluid gathering in the tissues).

Both hemorrhaging and edema lead to swelling.[5] While blood clotting usually happens within about 5 minutes of being injured & then stopping, edema can perpetuate the swelling well beyond 5 minutes.[6]

Most swelling is caused by edema. This is a result of the improved permeability of blood vessels as part of the inflammatory response.[7] The ice and cold causes the blood vessels to contract, thus stopping this leaking of fluid into the damaged tissues.[8]

However, this only works if the injury has cold applied to it very soon after the injury occurs. Apply cold within minutes for best results; sooner is better.[9] Cold decreases swelling, but does not treat it after it has happened- so you must apply it fast![10]

The best way to use ice is to apply actual ice to your skin. Ice stays at freezing temperature 'till it melts, and then just leaves more beautifully freezing ice.

If you have an injury that needs ice or need to prepare for future 'Rest Ice Compression Elevation' programs (and injuries), fill paper cups with water and freeze them. You can then rip the cup off the ice as the ice melts when you apply it to an injury.

And the cup gives you a handy grip for the ice.

If you're thinking that icing might give you frostbite, forget it.[11] Ice is just too warm to give you frostbite, if you're just applying it to an injury. But don't apply gel packs directly to the skin (use a paper towel or other barrier), since they can go below freezing and cause frostbite.[12]

But, giving yourself frostbite is really rare. If you soak your entire damaged limb in ice water for an hour and then keep applying gel-packs, yea, you will give yourself frostbite. But that's just stupid; use your common sense, and definitely never go to the point where you can't feel yourself because of the cold.

A NOTE ON APPLICATION: You should apply ice for 12-24 hours after your injury for best results, the sooner the better for the full benefits of 'Rest Ice Compression Elevation'.[13] Apply it for several minutes, on up to 30 minutes of ice for every 2 hours.[14]

However, ice is not very good for chronic injuries.

Ice can bring down the swelling, but if the inflammation is chronic then the inflammation has already happened and been going on for a while. You can't bring it down with an easy application of ice.

Also, you may have other problems that have symptoms similar to inflammation, but aren't actually inflammation. These could include trigger points, structural injuries, etc. For those problems icing can actually hurt you.

Trigger points especially respond positively to massage and being warmed up, as opposed to cooled.

So, a good rule of thumb is: If ice helps your injury and feels good, ice. If heat helps and feels good, apply heating pads.

◆ Compression

Compress the injury with a wide cloth bandage. The pressure of the bandage helps counter the effects of edema (fluid gathering in the tissues) because it helps keep the liquid from spilling out of the blood vessels, and also promotes reabsorption of the fluid by those vessels.[15]

As long as you have swelling going on, pressure can help to bring it down by, well, squeezing the fluid out. But, obviously, don't apply so much pressure that it hurts!

A gentle, continual pressure like that of a bandage will gradually help the swelling to go down. And even though externally applied pressure normally has no impact on normal fluid exchange, it will help bring down excess fluid swelling.[16]

For best results you should apply the pressure within a few minutes, along with the ice, and continue doing those for at least 24 hours.[17] The compression part of 'Rest Ice Compression Elevation' can last until you're sure that all the swelling is gone.

◆ Elevation

Elevating the injured body part decreases capillary hydrostatic pressure.[18] Basically, it lowers blood pressure so that less blood and other liquids collect and inflame the injury.

Less inflammation means less time spent waiting for the inflammation to go down. And less time 'Rest Ice Compression Elevation'ing until you get out there and start moving around again.

...And Stabilization

Stabilization is not technically a part of the 'Rest Ice Compression Elevation' regime, but it certainly helps. This is less about first aid and more about how to go about recovering after the first 24 hours of being injured.

For the best environment to recover, provide support for the injured body part so that the surrounding muscles can relax.[19] If those muscles are constantly contracted to support and keep the injury safe (calledmuscle guarding), then you can have other muscle tension/trigger point/unnatural movement issues later on.

Also, the tense muscles will tend to spasm, which just causes you more pain. Take time when bandaging yourself to not perpetuate your pain, and be comfortable when doing your 'Rest Ice Compression Elevation'.

Stabilize the injury so that as it's healing it can hang in a relaxed manner. Just like your body parts do normally when you're uninjured.

Remember, if you do a good beginner weight training program then you won't hurt yourself lifting. You won't need to do the 'rest ice compression elevation' routine, and your muscles will help stabilize and hold your body together, so you'll be less likely to get injured doing other active stuff.

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Rest Ice Compression Elevation: RICE for injuries
References:
1. Knight, Kenneth L. 1995. Cryotherapy In Sport Injury Management. Champaign, IL: Human Kinetics. Pp. 94.
2. Ibid.
3. Ibid. Pp. 85.
4. Ibid. Pp. 89.
5. Ibid.
6. Ibid.
7. Ibid. Pp. 90.
8. Ibid. Pp. 89.
9. Ibid. Pp. 90.
10. Ibid.
11. Ibid. Pp. 95.
12. Ibid.
13. Ibid. Pp. 98.
14. Ibid. Pp. 97.
15. Ibid. Pp. 91.
16. Ibid.
17. Ibid. Pp. 92.
18. Ibid.
19. Ibid. Pp. 93.